090107_INSPECTIONS_20171231

'lilt, : �,;�; .� Q Division ofSoil 4nd Water Copservatton:-;Operation'Review.. .. .
t -Q Divisionof Soil and Water Conservation'- Compliance Inspection i
Division of Water Quality Compliance Inspection
O;era n viewOttier Agency,- Op do Re �F a
Q Routine O Complaint O Follow-up of DW2 inspection O Follow-up of DSWC review 6 Other
Facility Number 09 I07 Date of Inspection 2-22-2000
Time of Inspection 10:40 24 hr. (hh:mm)
® Permitted ® Certified © Conditionally Certified 0 Registered [3 Not O erational Date Last Operated:
FarmName: ......................................................... County: Bladelx............................................. - FRO.--------....
OwnerName: Bob .......................................... 1.dixA[>PMt................................................. Phone No: 866-529.7.....................................................................
Facility Contact:.............................................................................. Title: .... Phone No:
Mailing Address: 20SO.Guinn.SbtatY..R&......................................................................... WMIC.Unk-K .................................................... 28399 ..............
Onsite Representative: Integrator:
Certified Operator:,yy.,RQb.cj:I............................ LWAgUAR ...................................... Operator Certification Number:169.53.............................
Location of Farm:
Latitude 34 ' 44 15 Longitude 78 • 40 30
Design Current
Design Current
Design Current
Swine Capacity Po ulation
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
JE1 Layer
Dairy
�,10
❑ Feeder to Finish
Non -Layer
Non-Dairy
Farrow to Wean
2400
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
2,400
i is
Total SSLW
1,039,200
oars
ENumber of Lagoons 2 ❑ Subsurface Drains Present ❑ lagoon Area ❑ rea Spray Field A
lding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [--]No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. 1f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): lb.. 19
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back
Printed on 3/7/2000

Facility Nrber: 09-107 Date of Inspection 2-22-2000
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Cl Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1$. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No vibfations°or defic.iencies.were;noted liming -this visit *You: Will:receive no ftirthei ;
•correspondence about this.visit. • • . . • - .. • � • • . • - . . .. • � • .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings,of facility to -better explain situations. (use additional pages as necessary):
Site visit was made to check lagoon levels. Did not speak to an on -farm representative. One of the markers did not appear to be I i
Reviewer/Inspector Name Jeffery Brown
Reviewer/Inspector Signature: Date:
T
on 3/7/2000

i♦ Routine O Cam taint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Date of Inspection
Facility Number o � G
Time of Inspection /F!7.� 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
MCertified ® Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _ .............. _ _ __ . ....... _.............. _.... ..
FarmName: L _'Jh � �C�'� .... ..._.... _. W ..... _ _ County:. _ � � -- _._. ....................... .
Land Owner Name: �'. ,�!^�! . "� ._ Phone No:
Facility Contact:... .. . _ . .... Title: _.._ _ _— ...—/yPhone No:
Mailing Address:
Onsite Representative:..... - ��'�'� '� Integrator:
Certified Operator: _.... % ...., �► �✓..... ._ . _.� _ ... ... Operator Certification Number: �.... ,
Location of Farm:
Latitude ` 6 " Longitude
Type of Operation and Design Capacity
:`; y. '"'y�".aS -ram;- se,%e �nz is3, "»0 -^&-' ,m.�x �,:' 4: x.� '.'^qa.'� 5'^**b mac- .�_?
)DCSiIA ;-Cu " ; f M,Q Design s CIICCCnt � k Design Cliri eIlt
�POn1 Cailea�� .,
Ca aci ,Po olation_.>wYk.,�_. Ca`aci :,k.Po elation`_. �.: �Ca aciPo ulahonr
❑ Wean to Feeder Layer ` ❑DM
❑ Feeder to Finish Non -La er<a < ❑ -Dauyl �'� mar '" ,� Y,q. - '"°, `�`� $"y
Farrow t0 Weanr"'"��x Vie,, z�,. i ", -_;'nv .M^..q�., °'-
'�,
Farrow to Feeder .Z O Total=DestgnCapactty;
Farrow to Finish
;8.e❑ Other s s•- E_ r �,rs"'a,d,,>�,.,, s �'�,.,�v,.,.
� ";^ae�,"*°7';'"sw,.^�<"a>',�„x, -:x,. _,„,,: �a.:e:-%:a_,��� s�.-r' � "�' _���x�"t;�:a *mCs..'��.'�-'a.��''.�'�,,�1"•
w Number of Lagoons ! Bolding Ponds Subsurface Drains Present
�
❑Lagoon Area Spray Field Area
Gegeral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes lff�o
❑ Yes ONO
❑ Yes /KNo
❑ Yes (No
❑ Yes gNo
❑ Yes )qNo
❑ Yes �No
❑ YesANo
Continued on back

FacilityN. bmber:..._&.q.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pop
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structury 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
❑ Yes �NO
❑ Yes 9No
❑ Yes r—I
❑ Yes X'No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Cedfiedail'
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Co6finintiVefer. to question #I) Explain at y YES answers and/or any recommen taons-or any other commentzS.
Use drawings of facility to Better explain situations: (use addittottal pages as necessary) i.'x w
❑ Yes )<No
❑ Yes '%No
,Yes ❑ No
❑ Yes )<No
❑ Yes Rr No
KYes
❑ No
❑ Yes KNo
,XYes ❑ No
❑ Yes P(No
❑ Yes X No
❑ Yes XVO
❑ Yes"No
X
❑ Yes �l No
RrYes /❑ No
Reviewer/Inspector Name. , ._
Reviewer/Inspector Signature: _ Date: P
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

r
Division of Soil and Water Conservation ❑ Other Agency
IS Division of Water Quality
19 Routine O Complaint O Follow-up of D%VQ inspection O Follow-up of DSWCC review O Other �
• Date of Inspection 7- P
Facili[�� Number p / O
Time of Inspection � 24 hr. (hh:mm)
© Registered ® Certified U Applied for Permit *Permitted Not O erational Date Last Operated :..........................
Farm Name:.........�f e.✓, s %....C.�U....... � V. .11 ............. County: ........... 1,7........................................................
Owner Name:......... f�+........! di 1/'� !J..... Phone No: i�� ..`..z..7.............
/........................................................ ......��............................................................
.. �y
Facility Contact: 4'!fi......t�Q,ef�✓!`�............ Title: Q �6
........................I.......................... .............................................
Flailing Address:............ "
.............
Ortsite Representative:.....!.......�a....✓s...."`........................................... ...................
Certified Operator s....[.:...`.... i.%1"� ..... Operator Certification Number, ...... 1� !., r-3 ..---...
Location of Farm:
A.
............................................... ....... ....................................................................................................................................................... ............................................................
.s ..--.. ..-- --- ............... ................. ................................ .
Latitude • =' =" Longitude • ' "
" xDesig�i ' Current
""� DesignCarrentF `Desrgrt v Ctirrent
Sw_me Capacity Populataan
-z Poultry CaPactty Population Cable Capacit3' �Populahon
.. #
❑ Wean to Feeder
❑ Layer ❑ Dairy ;
❑ Feeder to Finish
ID Non -Layer ❑ Non -Dairy ' :
,x
Farrow to Wean D
z,N. V.
Farrow to Feeder
❑Other
❑ Farrow to Finish
" Total Design Capacity ''
Gilts
❑ Boars
FNumber of Lagoons / Holdtittg',Ponds " zr ❑ Subsurface Drains PresentJ10 Lagoon Area ID Spray Field Area
�� `° "' ❑ No Liquid Waste Management System 7Ema 71
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass alagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons holding ponds) require
maintenance/improvement?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7I25197
❑ Yes R No
❑ Yes RQ No
❑ Yes KTNo
❑ Yes Wo
❑ Yes PQNo
❑ Yes RNo
❑ Yes RNo
❑ Yes Wo
❑ Yes kNo
❑ Yes XNo
Continued on back

t
Facility Number: 0,T— O"7
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures rLagoons.Holding Ponds, Flush Pits. etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4
identifier:
Freeboard (ft): .......... A` . ........... .........IVZ/...................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
❑ Yes ANo
❑ Yes RNo
Structure 6
....................................
❑ Yes NtNo
❑ Yes WNo
❑ Yes )KNo
r
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes XNo
Waste application
14. Is there physical evidence of over application? ❑ Yes RNo
40.
(if in excess of]W_M_P, orrunoffentering waters of the State, notify DWQ)
15. Crop type Ae"..'"pr�`f... :/�- a ,.e > ... .lYtrf,7�%. r ! ' ..................... .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ YesNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes KNo
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
P•No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PKNo
22.
Does record keeping need improvement?
❑ Yes
�<No
For Certified or Permitted Facilitio Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
AKNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
)&No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
A No
0° No.violations•oc de"ficiencieswerenoted"dtiring this,' visit.-.You:will ikeive.noftirtlier
:•corresporideneeab"out�this�visit:._.,: '•�..,:;;_:.•:;:•.. ; : ;.:, ;: .•::; ...... ,: :..__;•::
Nam/ _S A-KIV-14-
00,
/ �� 7125I97

ANIMAL OPERATION INSPECTION FORM
1. Date of Inspection(s): July 21, 2003.
2. Regional Office: Fayetteville, Water Quality Section
3. Name of Owner of Property: W. Robert Livingston.
4. Name of Operator: Turnbull Co. Farms, LLC.
5. Address: 2019 D�wd_Dai!y Rd.
White Oak. NC 28399
6, Phone Number: 910 866 - 5297,
7. Description of Facility Location, Map excerpt attached: Farm_ is located on the west side of SR 1332, 1 mile
south of the intersectiap with SR 1324,
8. Date this facility began operation: 4/26/1994,
9. Date of last expansion: Not applicable.
10. Has the facility registered with DWQ? if yes, date of registration: N/A_
11. Does the facility have an approved Animal Waste Management Plan: Yes
12. Has this facility received a CAFO Designation: NIA.
13. Type of Operation: Swine: Farrow to Wean.
14. Number and type of livestock: There were approximated 2,400 animals on the site at the time of inspection.
15. Length of time animals have been, are, or will be stabled, or confined and fed or maintained in any 12 month
period: Twelve (12) months
16. Are crops, pasture, or post harvest residues sustained in the normal growing season over any portion of the lot
or facility? Yes, facility was designed to utilize a pproximatel,V96_6 acres of land on which to apply waste. The,
certified waste management plan calls for bermuda hay and bermudag�razed both of which can be overseeded
with small grain. It also allows corn and fescue grazed as well.
17. Type of Waste Management System: Swine are kept in total confinement free stall barn with slotted floors over
w
18. Description of other animal operations in the immediate vicinity and proximity to same or other surface waters:
_A swine farm owned and operated by Mr. William_ R. Kinlaw , facility number 9-133, is about I mile to the
south .
19, Proximity of facility to neighboring houses, welts, etc.: The nearest residence is at a distance of than
l ,000 feet .
20. Approximate depth of ground water table in the area of the facility or discharge: Unknown.

21 _ Proximity of facility to surface waters: The UT extends through topoy-raphic drainage approximately .25 mile
to the Ellis Creek.
22. Animal waste discharged: Swine
Witnesses: LaMLBaxley, DWO-WQ Fayetteville Regional Office 910 486-1541
Paul Sherman. DWO-WO Fayetteville Recional Office [phone]
23. Are pollutants discharged in the waters of the State? YES
24. Do or have discharges occurred in response to a storm evcmt less severe that the 25-year, 24 hour storm? Yes
25. What is the degree and extent of harm to the natural resources of the State, public health, or to private property
resulting from the violation? The discharge has caused the introduction of nutrients into the receiving waters,
that will cause or add to the nossibility of algal blooms and accelerated eutrophication of the stream. There are
no known public health issues at this time. Waste discharges of this nature may, based on comments from Dr.
M.A_ Mixson, North Carolina Department of Aericulture, Veterinary Division, transport swine diseases if
conditions are suitable.
26. What is the duration and gravity of the violation? DWQ staff arrived at the Turnbull Co. Farms on the m_orping
of July 21, 2003 in response to a call received from Mr_ Livingston'S agent, Kathy Dugan. Ms" Dugan
explained that a plugged swine house discharge line had resulted in a spill and that cleanup and re air efforts
were being made, During the site visit wastewater was observed to be exiting and had exited a storm diversion
ditch adjacent to the lagoon. The wastewater then traveled several hundred yards through the woods and into an
unnam d tribu of Ellis Creek. Samples were taken in several locations. The farm manager stated that the
problem was discovered by one of his employees and they had repaired it immediately. The discharge was
estimated to be approximately 1,000 gallons by Mr. Livingston.
ABBREVIATED SAMPLE RESULTS
Location Coliform, Fecal
Source 3,100,000/ 100ml i
Downstream 58,000
Ellis Creek 10
Downstream
Ellis Creek 58
Upstream
27. Water Quality Assessment: No observed impacts to_wildlife in the receiving stream.
28. What is the cost of rectifying the damage? The cost of rectifyingdamage would have included recoverin
waste from the branch in the wooded area and retumin the waste to the lagoons orspray field.
29. What is the amount of money saved by noncompliance? N/A.
30. Was the violation committed willfully or intentionally? While closer monitoring of the lagoon area possibly
could have prevented or at least lessened the incidents impact it can not be stated that the violation was willfully
committed_
31. What is the prior record of the violator in complying or failing to comply with programs over which
Environmental Management Commission has regulatory authority? No prior record of violations.

tj
32. What is the cost to the State for the enforcement procedures?
Colifornt, Fecal: S23.40/ea X 4 samples S 93.60
Larry Baxley @ 19.03/hr X 2.0 hrs (Investigation) S 38.06
Drive time-2.Ohrs $ 38.06
Report Development- 8.Ohrs $ 152.24
Paul Sherman@ 28.12/hr X 2.0 hrs (Investigation) S 56.24
Drive time- 2hrs S 56.24
Central Office Review is 00.00
TOTAL $ 434.44
33. Type or general nature of business: Swine Farrow to Wean.
34. What is the violator's degree of cooperation or recalcitrance? Goo erative. The owner has taken steps lessen the
environmental impacts and has initiated policies to prevent a future occurrence.
35. Are there any mitigating circumstances? N/A
36. Assessment Factors:
a. IWC: Unknown
b. Receiving Stream: Unnamed ty-ibutga to Ellis Creek Class C Sw.
c. Damage: None observed at time of incident.
37. Include a copy of any Designation letter signed by the Director. NIA
38. Recommendations Made to Owner/Operator:
I- To actively monitor all areas of the waste management system.
2- To dig a small depression in the flow corridor and to pump the collected material back to the lagoon or on
to a spray field.
39. Recommendations for further DWQ Action:
I- Notice of Violation / Notice of Intent (Forwarded August 14, 2003)
2- Enforcement Action
3- Reins ection
40. Other Comments:

off_10 1
State of North Carolina
Department of Environment,
Health and Natural Resources 1 •
Fayetteville Regional Officeooftv
r
James B. Hunt, Jr., Governor p E H N F1
Jonathan B. Howes, Secretary
Andrew McCall. Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
Water Quality Section
July 13, 1995
Mr. Jimmy Vinson
Environmental Resource Manager
Brown's of Carolina, Inc.
Post Office Box 487
Warsaw, N.C. 28398
SUBJECT: Compliance Inspection
Turnbull Farms - Bob Livingston
NCSR 1332
Bladen County
Dear Mr. Vinson:
a-E0-
OnJ&me 12, 1995, a cursory inspection of the subject animal operation was performed
by the Fayetteville Regional Office. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided
by Browns of Carolina, Inc. staff and observations made during the inspection that the facility
is in compliance with 15A NCAC 2H, Part .0217 and the Animal Waste Management is being
property conducted.
Please provide a copy of this report to the individual farm owner or manger and should
you have any questions regarding this matter, please do not hesitate to contact this office at (910)
486-1541.
Sincerely'
Paul E. Rawls
Environmental Specialist
cc: DEM Compliance Group
Wachovia Building. Suite 714, Fayetteville, North Carolina 28301-5043 Telephone 910-46& 1541 FAX 910-4a6-0707
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Fare Name/Owner
Inspection Date
Farm No.
Bob Livingston
July 12, 1995
Nailing Address (Farm) Facility Telephone Number
2050 Gum Shaw Road J 910) 866-5297
White Oak, NC 28399
All comments will be discussed in the Comments Section.
SECTION I
Animal
Operation type: SWINE
SECTION xI
Y N Comments
1.
Does the number and type of animal meet or
exceed (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system) ]
X
2.
Does this facility meet criteria for Animal
Operation REGISTRATION?
3.
Are animals confined fed or maintained in this
facility for a 12-month period?
X
4.
Does this facility have a CtRTLf-IED ANIMAL WASTE
MANAGEMENT PLAN?
_X_ _ _#1_
5.
Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?

Administration and Program Management Y Cgmments
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc. _x_
Field Site management Y N Comments
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of USGS Map
Map Blue Line Stream? _ X _#1-
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does the facility have adequate acreage on
which to apply the waste? _x_
4. Does the land application site have cover
crop in accordance with the CERTIFICATION PLAN? _x_ _#3_
5. Is animal waste discharged into waters of the
state by man-made ditch, flushing system, or
other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices (BMP)
of the approved CERTIFICATION? _x_
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approx. 1.5 ft.) X
8. Is the general condition of this animal facility,
including management and operation, satisfactory? _x_
SCTION IV Comments
1. Farm has a certified waste management plan based on comments from Brown's
of Carolina staff.
2. The waste storage lagoon was observed to be adjacent to a USGS blue line
stream based on the Dublin, N.C. USGS Quadrangle dated 1987.
The lagoon was visually determined to just meet the 100 foot setback
requirement.

2. "continued"
Slight erosion was noted at the rear of the lagoon and the farmer is
asked to divert stormwater away from the dike area. The above noted
stream as well as the lagoon dike should be monitored on a frequent
basis. The lagoon dike should be well stabilized and mowed at all times.
It is recommended that a two foot freeboard be maintained at all time.
3. Observations made of the spray field revealed that a cover crop had been
established.

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date or Visit:1 J Time• $ •' S
- - -- - O Not Operational Q Below Threshold
Ij Permitted ® Certified 0 Co/nditionCertifiedlly Certified U Registered
/
Farm Name: ..�ur/N_ r1J,r SComaag .. 64'"i _
Owner Name: _ _ _I�� 2 G ''✓�/y� �� n
Mailing Address: __`l • , vG1 /1as'2� K
Facililt Contact:
Title:
Date Last Operated or Above Threshold:
County: a �20
Phone No: _ �5/0) ?
Phone No:
Onsite Representative: /i l Lij� .t os� /� 411W JiW ;JJ Integrator: 1770rn.4g- ,Af-o,r- O
Certified Operator: o c:� f - ,• r ✓ i H r, s N Operator Certification Number. . G 7 S3
Location of Farm:
0 Swine ❑ poultry ❑ Cattle ❑ Horse Latitude 0' 0" Longitude �• 0"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JV No
Discharge originated = 1_-]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes )0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes j0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: _ F a '-- wet _ • . _.� � _ _� .
Freeboard (inches): 411 3 q
12112M3 Continued

Facility Number. Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 19 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 6 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenancermiprovement? ❑ Yes Vf No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® No
elevation markings?
Waste Aanliration
I0. Are there any buffers that need maintenanc efmiprovement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive PonnJJding ❑ PAN j❑ Hydraulic Overload ❑ Frozen Ground �❑ Copper and/or Z=
12. Crop type — /S.o� E /7`.tN /Sra�anll �q �^ t�%s Q� / /�yc c c� z ��e�'r r't 9ra� �e 171IoZ11
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes IN No
15. Does the receiving crop need improvement? ❑ Yes jj No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [P No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building smicntre, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes qNo
Air Quality representative immediately.
Reviewerflnspector Name
Field Copy ❑ Final Notes
Reviewer/Iaspector Signature:
Date: /-I %1
12/12M3 1 / I Coniurued

Facility Number: % — %v7 Date of L spection
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28_ Does facility require a follow-up visit by same agency?
29. Were any additional problems noted whiacause noncompliance of the Certified AWMP?
NPDFS Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDF.S required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 0 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes W No
[:]Yes B No
❑ Yes VfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit ® Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason. for Visit ® Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
F2611iry Number b Date of Visit: Time:
� Not O erational Below• Threshold
® Permitted ® Certified 0 Conditionally Certified E3 Registered Date last Operated or I1Above Threshold: "',�,_
Farm Name: �� CS� County: ��CtiGCo
Owner Name: 0 p 6 �. [ 1r S Phone No: �(
Mailing _address: n i.-�l� D('t �i G . ('t
Facility Contact: ��.� 7 -ram Title: Phone No:
Onsite Representative: Integrator: ' o ry
Certified Operator: Q Q b Operator Certification Number:
Location of Farm:
Swine ❑ Poultry [3 Cattle [3 Horse Latitude Longitude �' �• K
Design Current Design Current Design Current
Swine Ca acih• Population Poultry Ca acity Po elation Cattle Ca achy Population
❑ Wean to Feeder ❑ Laver I I❑ Dairy
❑ Feeder to Finish ❑Non -Laver El Non -Dairy
® Farrow to Wean 2. 4 2
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
10 Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field.
No Liquid Waste Management Svstem
discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier: 0 e_v�
Freeboard (inches): 4a,
05103101
❑ Yes m No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 5a No
❑ Yes [�LNo
❑ Yes ZNo
Structure 6
Continued

Facility Number: iq — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �;No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [R,No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �;No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [RNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes (P No
12. Crop type A r,'.,. L. A.__ -1- (,,... , . ',
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes No
❑ Yes KI No
❑ Yes %No
❑ Yes � No
❑ Yes P No
❑ Yes J@ No
❑ Yes P No
❑ Yes ERNo
❑ Yes No
❑ Yes [ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer taquogd"E 444ny YES answers•andlortan�recamme©dattons yr any other comments.
'Notes
�...
Use; drawings ofrfacihty to,better ezplam situations
t� � i�.
(useisdditional pk""&asknecessary)u. Field - ❑ Copy El Final
�.-
cal-r,�
Reviewer/Inspector Name
{
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number: Date of Inspection f c7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes P,
No
❑ Yes �o
❑ Yes 0 No
❑ Yes DS No
❑ Yes � No
❑ Yes QJ No
❑ Yes ❑ No
---

Type of Visit @'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Koutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: lA_ Arrival Time: Departure Time: County: ���� Region:
Farm Name: �Gl r✓y /l �u 1 t��trti7dt►�7 S Vic. Owner Email:
Owner Name: Co., i V ; His= Phone:
Mailing Address:
Physical Address: !!
Facility Contact: Tithe: Phone No:
Onsite Representative: Integrator:
Certified Operator: Db ; Operator Certification Number:��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =' =' = Longitude: = e [=] ' = u
Design Current
Design r6nt
Design Current
Swine Capacity Population
T
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
/
❑ Dairy Heifer
9 Farrow to Wean R if D
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
El Non -Layers
El Beef Feeder
❑ Boars
❑Pullets
El Beef Brood Cow
-
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
I.No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
®-No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
JF[No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JRNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JKNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facilfty Number: — D7
Date of Inspection F 7_3_T (a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes tA No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: >5�05_7j_
Spillway?:
Designed Freeboard (in): _42ip 10
Observed Freeboard (in): 0 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ER No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes BNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? 9 Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
0
Wen
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C4 No
❑ NA
❑ NE
Ae,
Comments�(refer to question : Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facilityto better explain situations. (use;additioriai pages as necessary
$�. N,. r-ply �• �» .
V;S /7,-eL 7t"a its Ct7f cle)-
Reviewer/]nspector Name T. L­� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

sI Facility Number: q -" Date of inspection I X:3'0 -a b
' Reauired Records & Documents
14. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [STNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes K No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ES No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(M No
❑ NA
❑ NE
24.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R1No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ed No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
§No
❑ NA
❑ NE
Additional Comments and/or Drawings: .
Page 3 of 3 12129104

dill ttvision of Water Quality t�
Facility Number 0 Division of Soil and Water Conservation
O Other Agency ""l1
Type of Visit ®'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit [_TRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: �� County:
Farm Name: L L Owner Email:
Owner Name: i� ` ZZ, Phone:
Mailing Address:
Region: 1!!0
Physical Address: A
Facility Contact: �/aeah �.!y 'pie- Title: Phone No:
Onsite Representative: Integrator: /!l11.4&
Certified Operator: ®� _ :L� 0 ti Operator Certification Number: s3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = 0 Longitude: = ° = d =
dg
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry/Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design rCurre'
Cattle Capacity Popu at
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
J
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
12128104 Continued

Farility-Number: — &71
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:ly� 1i1�/S
Spillway?:
Designed Freeboard (in):��
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2 No [I NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
J4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
.Q No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
filNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z[No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP�
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ja No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JR No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): '
Re-0ewer/Inspector Name ��� %�-� Phone: 9/1y
Reviewer/Inspector Signature: Date:
12128104 Continued

r
Facility Number: — Date of Inspection FTE-22
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility Fail to have all components of the CAWMP readily available? if yes, check ❑ Yes DNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists [] Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste `transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JKNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CS No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit: &V Cliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r b M Departure Time: f County: Region: fff s
Farm Name: _u-V-4 - (l Q Owner Email:
Owner Name: 2s ' tI� -
Phone:
Mailing Address:
Physical Address:
Facility Contact: 2 r` eTitle: Phone:
I
Onsite Representative: Integrator: M 1 J - '5'_
Certified Operator: d b S K Certification Number: / 1 ? S3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
ty
CapaciME
Carregt
Pop.:
Design Carreut
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
UNon-La
Layer
Dai Cow
er
Dai Calf
o o
Design Earrent
De, P,oal Ca acit P,,o
Dai Heifer
DryCow
Non -Dairy
Z_
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
. E
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (lfyes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [� lQo ❑ NA ❑ NE
[:]Yes
[:]No
ENA
❑ NE
❑ Yes
❑ No
[ A
❑ NE
❑ Yes ❑ No
❑ Yes El -No
❑ Yes E]—No
Ef NA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facili Number: I - tft 7 Date of Inspection: S 69Gr
(Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ iN-o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
,C-,I'NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[:J�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�3<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
to
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[?"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P'"fo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop, ,Window ❑ Evidence
'of�Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C'94T0 � d+1 ky"t-'-"f CF.<4idS-6 a
13. Soil Type(s): tJ ibi �}J Lee eJR '-L c�( &'),kG e-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[31 No
❑ NA
❑ NE
R uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-No
❑ NA
❑ NE
the appropriate box.
'
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes Ej No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [�`No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes CNo
❑NA []NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA []NE
Page 2 of 3 21412015 Continued

Facility Number: 61 - O Date of Inspection: Z Y 0.
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 0 Yes [L..N-a ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�Wo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Cg-?46 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
i a �-Y
C�
q (o- Sag-4d 51
[-]Yes G-Iqo- ❑NA ONE
[::]Yes Cql`' ❑NA ❑NE
❑Yes E!No ❑NA ❑NE
[:]Yes ❑L'No ❑ NA ❑ NE
❑ Yes �fNo
❑ Yes [^-NNo
❑ Yes [2 o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: 13 1 l r� ZU _ _ Phone:'TP- IS3-�3%33`�
Reviewer/Inspector Signature: 1 Date: F L-)C-( 1
Page 3 of 3 21412015

lws 1E
IType of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: C rkoutine O Complaint 0 Follow-up O Referral O Emereency O Other O Denied Access
Date of Visit: Arrival Timer Departure Time: County: Region:
Farm Name: _ tccr+,{gwtj-S Owner Email:
Owner Name: t4Lo Phone:
Mailing Address:
Physical Address: /�
Facility Contact: CL at, g�'e r Title: Phone:
Onsite Representative: integrator: �— s
Certified Operator: 6-e - L Cti Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
9 2-AS 013 zs, k v Z a ( _ PC -r 0 4'—
Design Current;,
#
Design
Current
Design Carrent
Swine
Capacity Pop:
.. _ Wet Ponitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul
Ca ati
Pao ,
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
I 113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
N.
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
®moo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�TA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[3"NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
C3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFatili Plumber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ZJ'iQA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �io ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[aKo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[BAo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[E�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[rf -No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[.J No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U-N'o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): S G O
ccw-lit.
13. Soil Type(s): C,%� % Ct-G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [? f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [3'No 0 NA ❑ NE
0 Yes [2-No ❑ NA 0 NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�Wo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EJ'No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ?[ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - / Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MX ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z,?To' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2-lq-o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2 o ❑ NA ❑ NE
❑ Yes [�]`o ❑ NA ❑ NE
❑ Yes El"'No ❑ NA ❑ NE
❑ Yes [210 ❑ NA ❑ NE
❑ Yes E] No
❑ Yes e'No
❑ Yes ED"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: GcP_C) • Date:
Page 3 of 3 21411 11

M Division of Water Resources
❑ Division of Sail and Water Conservation
❑ Other Agency
Facility Number:
090107 Facility Status: Active
permit: AWS090107
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine County:
Bladen Region:
Fayetteville
Date of Visit:
12/16/2015 Entry Time: 09:00 am Exit Time: 10:00 am Incident S
Farm Name:
Tumbull Company Farms, LLC
Owner Email:
[e-mail]
Owner:
W Robert Livingston
Phone:
910-866-5297
Mailing Address:
2019 Dowd Dairy Rd
White Oak NC 283999783
Physical Address:
1901gum Shaw Rd
White Oak NC 28399
Facility Status:
0 Compliant ❑ Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
34° 43' 56" Longitude:
78" 40' 25"
On west side of SR 1332, 1 mile south of intersection with SR 1324.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator:
W Robert Livingston
Operator Certification Number.
16953
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Banter Phone :
On -site representative Kathy Barker Phone:
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Calibration September 2014
Sludge Survey Sept 2014 Primary 0-6.4, P-4.4 42%
page: 1

1
permit: AWS090107 Owner - Facility : W Robert Livingston Facility Number: 090107
Inspection Date: 12/16/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
swine - Farrow to Wean 2,400 2,296
Total Design Capacity: 2,400
Total SSLW: 1,039,200
Waste Structures Observed
Disignated
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
09-107-1
26.00
28.00
Lagoon
09-107-2
26.00
1 26.00
page: 2

Permit: AWS090107 Owner - Facility : W Robert Livingston Facility Number: 090107
inspection Date: 12/16/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea No Na No
1. Is any discharge observed from any part of the operation?
❑
[]
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
0
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
No
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes,
No Na No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
S. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9._ Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
[]
PAN?
❑
Is PAN n 100/o/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

N
Permit: AWS090107 Owner - Facility : W Robert Livingston Facility Number: 090107
Inspection Date: 12/16/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na No
Crop Type 1 Coastal Bermuda Grass
(Hay)
Crop Type 2 Coastal Bermuda Grasswl
Rye Overseed
Crop Type 3 Com, Wheat, Soybeans
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Norfolk
Soil Type 3
Roanoke
Soil Type 4
Kenansville
Soil Type 5
Soil Type 6
14, Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15_ Does the receiving crop and/or land application site need improvement?
❑
M ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yea
No Na Na
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20_ Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below,
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other
❑
If Other, please specify
21 _ Does record keeping need improvement?
❑
M ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS090107 Owner - Facility : W Robert Livingston Facility Number: 090107
Inspection Date: 12/16/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na Ne
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22 Did the facility fail to install and maintain a rain gauge?
[]
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
■ ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
Yes
No Nae
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
E ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewedlnspector fail to discuss reviewrinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Type of Visit: ffCompliance Inspection U Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: &1�0'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �=-J County: U P ti
Farm Name: l !7n ✓v-f Owner Email:
Owner Name: S. FAe . ;.v\ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: i'1?
Certified Operator: �--"i �V Certification Number: IJ-�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
R'et Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
0 +A
Design Current
D . $oultr Ca a_ ' P,o
Layers
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [�J`NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [—]No [3"'NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes 2;40 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes FNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facil' Number: ZPJ- Date of Inspection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes C3('Ivo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identi Fer:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes !f No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C3"10 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [J No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [No ❑ NA ❑ NE
maintenance or improvement?
Waste Auu6cation
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes �1 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [T No ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IJ<
❑ NA
❑ NE
❑ Yes
[2-No
❑ NA
❑ NE
❑ Yes
[Ejl�o
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z3"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [D6io ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FZKNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9"'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fffNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number- Uti- Date of Inspection: cc 7211
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes R� o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [5 o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
g3/No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERI&
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2-14o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C3 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA ❑ NE
Comments (refer to question #). Explain any YES; answers,andlor any additional;recolnmeadations:orFany other comments.,: -..; " _- -
Use drawings of facility to better explain situations (use additional pages as necessary).
Cc,Lc b4l CD�i —
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 17
e-c- 44
Oe?-- �Kt �o,y
It
Phone: Ll
Date: fp—
v:_c 1
2/4/20I4

ca
Type of Visit: (compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: (34outine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: is Arrival Time: d t Departure Time: 1 Pg"OJ County:
Farm Name: %�n!� �L LC Owner Email:
Owner Name: L r`vi /yl Phone:
Mailing Address:
Physical Address:
RegioTIZZ
Facility Contact: P4108CTitle: e Phone:
Onsite Representative: l Integrator:
Certified Operator: , Certification Number: 16 `s 3
Back-up Operator: Certification Number:
Location of Farm: \ Latitude: Longitude:
Design CuReut - Design Current . Design Current
Swine Capacity PoppR Wet Poultry Capacity Pop" Cattle Capacity Pop.
r p
Wean to Finish,, Layer DairyCow
Wean to Feeder Nan-11 Layer , . ; DairyCalf
Feeder to Finish DairyHeifer
Farrow to Wean P Design Current D Cow
Farrow to Feeder D : Poult . Ca aci Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers 113eef Feeder
Boars Pullets 113cef Brood Cow
Turkeys
Other n Turkey Poults
Other I Other rr y
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E301<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
GJNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
❑ No
[7],NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
02'NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yeso
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Iio
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

:r
•' t12
Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
["No ❑ NA ❑ NE
E No ❑ NA ❑ NE
Structure 6
❑ Yes [2'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
['No
[DNA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public stealth
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[ "No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
[:]Yes
�No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
{014o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ "No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated iri the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[—]Yes [],No ❑ NA
[:]Yes [!"No ❑ NA
❑ Yes
❑'No
❑ NA
❑ Yes
[D,<o
❑ NA
❑ Yes
[a<o
❑ NA
❑ Yes �o ❑ NA
❑ Yes [�10 ❑ NA
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2**�o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ '* o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &2"No
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

.i
,
f
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
®No
[DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ca"No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
V-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Cg'lqo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Wo ❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CDAo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑Ao ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments-�t
Use.drawinSs.of facM v to.better explain situations (use additional pages'as necessarv).
C - (rGV44'%
i4 9 A9
©C,/ Z6N
❑ Yes [j�No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes (2 No ❑ NA ❑ NE
[:]Yes Q No ❑ NA ❑ NE
3( zoclf
Reviewerhnspector Name: `1 Phonb: r D 6
jj
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G�*outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:County: Region: H70
Farm Name: �� t I O tw Owner Email:
Owner Name: J3 b T-� itV l Phone:
Mailing Address:
Physical Address:
Facility Contact: A .34 L` e14 Title:
Onsite Representative: f
Phone:
/r1 Integrator: k
Certified Operator: ob ��U1 IV-1-Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Sw1111111!11
Finish
Design Current
et Poultry
Layer
Design
Capacity
Current
Pop.
C*attle
DairyCow
Design Current
Capacity Pop.
Feeder
Non -La er
Dai Calf
to Finish
DairyHeifer
Farrowo Wean
o Feeder
a
D P,oultr
Design
Ca aci
Current
P.o
D Cow
n-Dairy
o Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
Boars
Other
Otber
Pullets
Turkeys
Turkey Poults
t 10ther
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
[i/A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:3 No
E A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[;K4o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dN o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Num er: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[R'11o_
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Go-'5A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ej o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ER'&o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ 'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[6 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[30N'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3`1�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6
13. Soil Type(s): p "a_� (-*'--C_
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes U2-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑moo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes G:�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EDNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[� o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
❑.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
to
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [—]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2114o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E'No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection-:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes -@R o ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®'o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [alto ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [!INo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[]'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNV?
❑ Yes
['!Io
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
0No
❑ NA
❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date: '��
21412014

Type of Visit: otnpliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine. 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: - 's County: Region:
Farm Name:_5014.6t [',, t-i=/'.
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: aok. � Title: Ehc , c-w Phone:
Onsite Representative: Integrator: '�0WP%__
Certified Operator: S�A b �,—,� ; ✓7 *7. 1T?—Y%, r- Certification Number: % 9, _f; 4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design .Current
Design Current
Swine Ca aci Po
..
Wet PouIt . Ca s ' ry p cyty Pop.
Cattle Capacity Pap.
w s.=�_iriec
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
p
Design Current
Cow
Farrow to Feeder
D , P.oultr. Ca aei P.o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
LBeef
Brood Cow
5"...
Turke s
Other
jr
"_``
Turke I'oults
Other
I
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 5RjSIo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes [,No
❑ Yes V1 No
❑ NA ❑ NE
❑NA ❑NE
NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Nqmber: - Date of Inspection: -�
Waste Collection & Treatment
= 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[NNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3-No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E.No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
gNo
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
B.No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EZ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
CE;-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): lZal' Ilc1r's'c,Yr �GOrft �l%I //
13. Soil Type(s): .t;Li2* c_ K,�71 Li �}�rn.Q-�S(1r� /Z(20j 0_k-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes Dff No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes S No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ('No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciEi N#rmher: IT - Date of Inspection..
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KI No ❑ NA ❑ NE
25. Is the facility out of compliance with pen -nit conditions related to sludge? If yes, check [:]Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E, No
❑ NA
❑ NE
and report morality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�LNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
PNo
❑ NA
❑ NE
Comments (re er to question #) Expl_atn any_YES�ansi►ers,and/or ts. any additional recommendatrans oranyotber commen
';
Use drawings of facrl ty to better exptarn=srtuattans,;(use addrhOnal,pages°as necessary.)„
f , :,
d
Reviewer/Inspector Name: A01X_
Phone:
Reviewedlnspector Signature:
Date:
Page 3 of 3
21412011

� 1� VISIOIt;Of�Watefr UM �-? t
Facility Number plDnt onof Soil andWater Conserve on
w� -
MA
Type of Visit: Cwetkmpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 _5_--6—jj Arrival Time: 12,1;70� Departure Time: County: ff� Region:
Farm Name: �� Owner Email:
Owner Name: 1�� , Yj rem s%fj-f Phone:
Mailing Address:
Physical Address:
Facility Contact: j�a,�;yi r�¢S]�1--�� Title: Phone:
Onsite Representative: �d'p s]/--y Integrator: WIW19.246
Certified Operator: �b e e�� �� ngs%p , Certification Number: Z4 2 5' T
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design 50
Design Current
Design Current
Swim
Capactt3 Pop.
Wet Poultry
Capacity 1'op
Cattle Capacity Pop.
Wean to Finish
La er
— — — —
Dairy— Cow
Wean to Feeder
Non -La er
-
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
V
gam.,
D Cow
Farrow to Feeder
Dairy
Farrow to Finish
Beef Stocker
Gilts
=
Beef Feeder
Boars
Beef Brood Cow
_.
Other`.
, t
MI Other
e:
Design ,Current��
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impact
1- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
fD No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili tiiumber: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 'Z
Observed Freeboard (in): _ 00-L
5. Arc there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes gg No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C,No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [KNo ❑ NA
❑ Yes [a No ❑ NA
[:]Yes [a No ❑ NA
❑ Yes ED No ❑ NA
❑ Yes ® No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. VLYes � o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste 'transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [g No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• f4sci ' `Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®. No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [A No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Q No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [M No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
Ec No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
E0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�R No
❑ NA
❑ NE
Comments (refer to. question #): Explain any YES answers and/or any additional recommendations or any other comments , ,
Use drawings of. facility to.Fbetter explain situations (use additional pales as necessary}. - * ^ �,�
Reviewer/inspector Name:
ReviewerlInspector Signature:
A1,2e, '4,4all
Phone: g/O-- !% .� Q
Date:
21412011
Page 3 of 3

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ontine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Affrival Time:
/�� Departure Time: %O County: 1&AteAJ
Farm Name: 1 G--d�r^d i i 6_t04nSZI&C Owner Email:
Owner Name- Phone:
Mailing Address:
Region:
Physical Address:
j t
Facility Contact: OPQC2u v+fit s Title: Phone No:
Onsite Representative: &6✓I I Integrator: fir/ 6
Certified Operator: W Ly/NtS Operator Certification Number: %
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 t ❑ s, Longitude: ❑ o ❑
0
�Pop51
❑ Wean to Finish _
F1�ean to Feeder
ion
eder to Finish
Farrow to Wean 'L D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacih' Population
�rrr�
❑ Layer
❑ Nan -Layer FEE
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
E]Dairy Heifer
❑ Dry Cow
❑ on -Dairy
El ❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Ekflo ❑ NA ❑ NE
❑ Yes
❑ No
MPQA
❑ NE
❑ Yes
❑ No
Q4A
❑ NE
[94A
❑ NE
❑ Yes
❑ No
❑ Yes
Q,110
❑ NA
ElNE
ElYes
CK.
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility. Number:Date of Inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
['lo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
G146 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): elkee
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
D o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
Lto ❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
[R o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
El0
��,�
14 ❑ NA [:1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
I--]tw Yes
,,-�,,``
o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ 0 Evidence of Wind Drift El Application Outside
of Area
12. Crop [ype(s) �-�(� f L/Ut0Zf So >;r-4r-.e
13. Soil type(s)
UA
' 11 0'
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
//
2 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EY1 No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�`No
❑ NA
❑ NE
to;',question 6VEapl2tn any YES:
/-A-t-
ReviewerAnspector Name
Reviewer/Inspector Sigpo
Page 2 of 3
/" R-A-4r'
fl-T�ef
rs �,
= WE
Phone: �cS3J
Date: /d
12128104 Continued

/
Facility- Number: 2�9 — �Q Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes R o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L7No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
5PNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
El Yes
LldNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L_",/No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
LEI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E1�40
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E;KNo ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ff No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
ErNo
Er
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments sudlor DraHings ry„ H,,
Page 3 of 3 12128104

�.Tl)ivision of Water Quality
Facility Number Q % 0 Division of Soil and Water Conservation
_ -.--..._.... 0 Other Agency
Type of Visit
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
�om�pliance
routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: -D 11-O q Arrival Tint,: Departure Time: /Q. +I f County: 914J42•'✓ Region:
Farm Name: I JY y "' Owner Email:
Owner Namez+ ' •" Phone:
Mailing Address:
Physical Address: ,/ f
Facility Contact: r1 et N Title: _ . �i �' Phone No:
Onsite Representative: Ds vlar" Integrator: �
Certified Operator: -Rob t u-. j510AJ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 a 0 A 0 « Longitude: = o = 1 =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
B
1 Z S'b p
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cattle
Design Current
Capacity Population
i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes u No ❑ NA ❑ NE
❑ Yes
❑ No
ENA
❑ NE
❑ Yes
❑ No
E NA
❑ NE
❑ Yes
❑ No
[2iA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 49 — % Date of Inspection
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes O,_.,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L�J No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [3 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E!rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require El Yes l� No [I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
21 No
❑ NA ❑ NE
maintenance/improvement?
IL
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
��,,//
t�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Cropt'pe(s) w....c����`ff-- Sv^cj�rn,..� �D.SC.lJl�n% i i�t-� fi+�li�r_•-� ►a.
13.
Soil type(s) yel /te &c Ijc Kc_ WeLAP t_
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Bo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
L2'No
❑ NA ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
C o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
2 o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
L�'<o
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �j CIS Xe V,,f,5 : Phone: TO,433. 3 33 �
Reviewer/Inspector Signature: Date: 6 -o y - 20 0
I2124VU4 Continued

' Facility Number: —/tj Date of Inspection
Required Records & Documents• ,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElE Yes No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
BNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
//
9 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
L3NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CKJA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
C3 tVA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
El No
�[]
h� NAA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
Doi A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
L3I NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
E34A
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
EjKA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
E?f4A
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
Q,rA
❑ NE
Additional.Comments and/or Drawings:
12128104

r
Type of Visit I�Kompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t511outine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 17 Departure Time:: County: ^ Region:
Farm Name: �y %bzea jfQx2a ogffA6� / i:5irMA Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �� h L/% I2R-S ��� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 60��3
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 1 =" Longitude: = ° = ' F-1 "
❑ Wean to Finish
DesignrP11.PuU'.Mi�C_1tf `=
Wet Poultry
.
❑ Layer
Design Curnt
C►opacity Population
Designom
Gat#!e Capacity
Popula.:
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
.
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
El Non -Layers
ElBeef Feeder
PGilts
O❑Pullets
sBoars
❑ Beef Brood Co
❑ Turkeys
Other,t.
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UqNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[R.No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

l I
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�I'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 14 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CS No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes i[No ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wilnd Drift ❑ Application Outside of Area
12. Crop type(s) lJLlro- Ldlrp l gt/` S�G'dr /
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CKNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
PL No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
%No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or anv recommendations or any other comments , ; t
Use drawings of factltty to better explainsituations. (use additional pages asanecessary)
r$;0-- C'ovcr -�
Reviewer/Inspector Name
Phone: _12f 3110
Reviewer/inspector Signature:
Date: *� I/ `
Page 2 of 3 12128104 Continued

' Facility Number: — 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 9Yes - 0fo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5TNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [2�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J ANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
69-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gLNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
04 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fallo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
Additional Commetiits an'dlor Drawings
Page 3 of 3 12128104